Formulir Pembinaan Etik
Formulir Pembinaan Etik
Hari / Tanggal :
Nama :
NIK :
Ruangan :
Masalah :
Uraian kegiatan :
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Dengan ini mengusulkan kepada Tim Komite etik dan disiplin profesi keperawatan /
kebidanan untuk menindaklanjuti masalah tersebut diatas.
Jakarta,..................................., ......
Nama Perawat
Mengetahui
( ........................................ ) ( .................................................. )
FORMULIR PEMBINAAN STAF INTERNAL
RS RUMAH SEHAT TERPADU DOMPET
DHUAFA
1. Hari / Tanggal :
2. Nama :
3. NIK :
4. Ruangan :
5. Masalah :
6. Uraian kegiatan :
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Bogor,..................................., ......
Atasan Langsung
( .................................................. ) ( ..................................................... )
Nama Perawat /Bidan
LAPORAN KEJADIAN PELANGGARAN KODE ETIK DAN
DISIPLIN PROFESI PERAWAT DAN BIDAN
RS RUMAH SEHAT TERPADU DOMPET DHUAFA
Nama :
NIK :
Ruangan :
Masalah :
Bogor,..........................
Dilaporkan oleh,
(..........................)
Ketua Sub Komite Etik dan Disiplin profesi